Pancreatic thickness, the only significant predictive factor for pancreatic fistula after distal pancreatectomy

Background Distal pancreatectomy (DP) is the main surgical treatment of benign and malignant lesions located in pancreatic body and tail. Postoperative pancreatic fistula (POPF) following DP is still a considerable cause of morbidity. Identification of risk factors for POPF after DP might provide some preventive applications. We aimed to evaluate the factors affecting POPF after DP and to present a new and easy radiological predictive factor. Materials and Methods Thirty-four patients underwent DP with stapler closure were included. Several risk factors for clinically relevant POPF (CR-POPF) were analyzed. Additionally, computed tomography findings of pancreatic thickness (PT), main pancreatic duct diameter (MPDD), and PT/MPDD ratio were evaluated for POPF. Results CR-POPF was observed in 10 patients (29.4%). Univariate and multivariate analyses showed that previous abdominal surgery and PT/MPDD ratio were predictive factors for CR-POPF after DP ( P = 0.040, P = 0.034, respectively). The cutoff value for the PT/MPDD ratio was 8. Conclusion A PT/MPDD ratio greater than 8 (a wide pancreas with a narrow duct) is a significant predictive factor for CR-POPF following DP.

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Relationship between pancreatic thickness and staple height is relevant to the occurrence of pancreatic fistula after distal pancreatectomy

HPB ◽

10.1016/j.hpb.2019.07.010 ◽

2020 ◽

Vol 22 (3) ◽

pp. 398-404 ◽

Cited By ~ 3

Author(s):

Motokazu Sugimoto ◽

Michael L. Kendrick ◽

Michael B. Farnell ◽

Shogo Nomura ◽

Naoki Takahashi ◽

...

Keyword(s):

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Pancreatic Thickness

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Stapler sizes optimized for pancreatic thickness can reduce pancreatic fistula incidence after distal pancreatectomy

Surgery Today ◽

10.1007/s00595-019-01929-z ◽

2019 ◽

Vol 50 (6) ◽

pp. 623-631 ◽

Cited By ~ 3

Author(s):

Makoto Nishikawa ◽

Junji Yamamoto ◽

Mayumi Hoshikawa ◽

Takahiro Einama ◽

Takuji Noro ◽

...

Keyword(s):

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Pancreatic Thickness

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Has the pancreatic fistula already occurred in the operation? An intraoperative predictive factor of clinical relevant-postoperative pancreatic fistula after the distal pancreatectomy

Surgery Open Science ◽

10.1016/j.sopen.2019.04.003 ◽

2019 ◽

Vol 1 (1) ◽

pp. 38-42

Author(s):

Weishen Wang ◽

Hao Qian ◽

Jiewei Lin ◽

Yuanchi Weng ◽

Jun Zhang ◽

...

Keyword(s):

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Predictive Factor ◽

Postoperative Pancreatic Fistula

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The Impact of Stump Closure Techniques on Pancreatic Fistula Stratified by the Thickness of the Pancreas in Distal Pancreatectomy

Digestive Surgery ◽

10.1159/000505061 ◽

2020 ◽

Vol 37 (4) ◽

pp. 340-347

Author(s):

Nobuyuki Watanabe ◽

Yusuke Yamamoto ◽

Teiichi Sugiura ◽

Yukiyasu Okamura ◽

Takaaki Ito ◽

...

Keyword(s):

Risk Factors ◽

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Operation Time ◽

Receiver Operating Curve ◽

Receiver Operating Curve Analysis ◽

Stump Closure ◽

Independent Risk Factors ◽

Pancreatic Thickness ◽

The Impact

Background: The purpose of this retrospective study was to evaluate the impact of stump closure techniques on pancreatic fistula (PF) focusing on pancreatic thickness after distal pancreatectomy (DP). Methods: A total of 213 patients who underwent DP between 2007 and 2017 were retrospectively reviewed. The risk factors of PF were investigated. Results: In all patients, age ≥65 years (odds ratio [OR]: 3.60, p = 0.012), operation time ≥300 min (OR: 3.05, p = 0.013) and thickness of transected pancreas (OR: 1.37, p < 0.001) were identified as independent risk factors for clinically relevant PF. A receiver operating curve analysis revealed the optimum cut-off values of thickness to be 14 mm with stapler closure and 17 mm with the clamp-crushing method. There were no significant differences regarding PF between the stapler closure and clamp-crushing methods in the thin (<14 mm) and very thick pancreas (≥17 mm) groups (p = 0.822, p = 0.072). In contrast, stapler closure was the only independent risk factor for developing PF in the moderately thick (≥14, <17 mm) pancreas group (OR: 6.75 and p = 0.004, respectively). Conclusion: The clamp-crushing method was superior to stapler closure for pancreatic transection, especially in patients with moderately thick pancreas.

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Prediction of pancreatic fistula after distal pancreatectomy: Is it necessary to place prophylactic drain?

International Surgery ◽

10.9738/intsurg-d-19-00008.1 ◽

2020 ◽

Author(s):

Kazuhiro Suzumura ◽

Kenjiro Iida ◽

Hideaki Iwama ◽

Yusuke Kawabata

Keyword(s):

Body Mass Index ◽

Multivariate Analysis ◽

Confidence Interval ◽

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Body Mass ◽

Predictive Factors ◽

Odds Ratio ◽

Drain Placement ◽

Pancreatic Thickness

The aim of this study was to determine the predictive factors for pancreatic fistula (PF) after distal pancreatectomy (DP) among preoperative and intraoperative parameters, and to clarify the patients who did not require drain placement. Between July 2009 and April 2017, 102 consecutive patients underwent DP at Hyogo College of Medicine. Preoperative and intraoperative data were collected, and the predictors of PF after DP were identified. PF was identified in 35 (34%) patients. In the multivariate analysis, 3 factors (body mass index [BMI] ≥22.4, contiguous organ resection, and pancreatic thickness ≥11 mm) were found to be independent predictors of PF (odds ratio, 5.7; 95% confidence interval, 1.9-17, p=0.002, odds ratio, 6.7; 95% confidence interval, 1.6-28, p=0.009, odds ratio, 11.6; 95% confidence interval, 3.7-36, p<0.001, respectively). A scoring scale for the prediction of PF was developed. BMI ≥22.4 (score: 1), contiguous organ resection (score: 1), and pancreatic thickness ≥11 mm (score: 2) were included in the scoring scale. Patients with a score of 0 never developed PF, while PF occurred in all patients with a score of 4. BMI ≥22.4, contiguous organ resection, and pancreatic thickness ≥11 mm were predictive factors for PF after DP. No patients with BMI <22.4, no contiguous organ resection, and a pancreatic thickness of <11 mm developed PF after DP, indicating that such patients may not require drain placement.

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Wrapping the pancreas with a polyglycolic acid sheet before stapling reduces the risk of fluid collection on the pancreatic stump after distal pancreatectomy

Surgical Endoscopy ◽

10.1007/s00464-021-08387-0 ◽

2021 ◽

Author(s):

Ji Su Kim ◽

Seoung Yoon Rho ◽

Dong Min Shin ◽

Munseok Choi ◽

Chang Moo Kang ◽

...

Keyword(s):

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Fluid Collection ◽

International Study ◽

Polyglycolic Acid ◽

Previous Method ◽

Tertiary Referral ◽

Tertiary Referral Hospital ◽

Pancreatic Stump ◽

Resection Line

Abstract Background Postoperative pancreatic fistula (POPF) and postoperative fluid collection (POFC) are common complications after distal pancreatectomy (DP). The previous method of reducing the risk of POPF was the application of a polyglycolic acid (PGA) sheet to the pancreatic stump after cutting the pancreas with a stapler (After-stapling); the new method involves wrapping the pancreatic resection line with a PGA sheet before stapling (Before-stapling). The study aimed to compare the incidence of POPF and POFC between two methods. Methods Data of patients who underwent open or laparoscopic DPs by a single surgeon from October 2010 to February 2020 in a tertiary referral hospital were retrospectively analyzed. POPF was defined according to the updated International Study Group of Pancreatic Fistula criteria. POFC was measured by postoperative computed tomography (CT). Results Altogether, 182 patients were enrolled (After-stapling group, n = 138; Before-stapling group, n = 44). Clinicopathologic and intraoperative findings between the two groups were similar. Clinically relevant POPF rates were similar between both groups (4.3% vs. 4.5%, p = 0.989). POFC was significantly lesser in the Before-stapling group on postoperative day 7 (p < 0.001). Conclusions Wrapping the pancreas with PGA sheet before stapling was a simple and effective way to reduce POFC.

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